Fillable DIRECT DEPOSIT REQUEST FORM

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DIRECT DEPOSIT REQUEST FORM

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2525 E. Camelback Rd. Ste. 1101, Phoenix AZ 85016 Phone: 602-279-9663 Toll Free: 800-640-0635
DIRECT DEPOSIT REQUEST FORM
DATE: ___________________
CUSTOMER NAME: ________________________
WESTSTAR ACCOUNT NUMBER: ___________________________
DEPOSIT FUNDS TO:
BANK NAME: _________________________________________________
ABA ROUTING/TRANSIT NUMBER: ________________________________
BANK ACCOUNT NUMBER: ______________________________________
CHECKING: _________SAVINGS: _________
Please accept this letter as your authorization to electronically deposit proceeds from the above
referenced collection account, I understand this service is provided as a convenience to me, and
Weststar Pacific Mortgage (Weststar) shall have no responsibility for the bank’s failure to make the
deposit to my account, or for the bank’s charges relating to the deposit. Weststar’s liability is limited to
the prompt deposit of funds. I understand it is my responsibility to inform Weststar of any monies
deposited into my account by Weststar which are not due to me.
_____________________________
Authorized Signature
*Please include a voided check or printout from your bank showing the routing and account number.
This will ensure accuracy when the prenote is sent to your bank.
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DIRECT DEPOSIT REQUEST FORM

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Completed 2 December 2021

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